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A man reads an educational pamphlet as he waits for an HIV test at a free mobile testing center in Los Angeles offered by the AIDS Healthcare Foundation and the Magic Johnson Foundation.
The new HIV screening recommendations from a national task force cast a much wider net than they did in their previous form, calling for the testing of virtually every adult and many teenagers.
The U.S. Preventive Services Task Force announced on Tuesday that it is recommending that health providers screen the following groups for HIV:
- All people ages 15 to 65, regardless of whether they are considered high-risk.
- Younger teenagers and older adults "who are at an increased risk for HIV infection."
- All pregnant women, "including those in labor whose HIV status is unknown."
This aligns the task force's recommendations more closely with those from the Centers for Disease Control and Prevention (CDC), the American College of Physicians and the American Academy of Pediatrics. Previously, the U.S. Preventive Services Task Force hadn't included so many people in its screening guidelines, omitting teenagers and adults who weren't known to be at an increased risk of infection.
While the task force didn't have enough evidence to definitively say how often people should be screened for the virus, it did suggest screening "very high risk" people at least once a year and people who have an increased risk every three to five years. As for their lower-risk counterparts:
Routine rescreening may not be necessary for individuals who have not been at increased risk since they were found to be HIV-negative. Women screened during a previous pregnancy should be rescreened in subsequent pregnancies.
HIV, the virus that causes AIDS, affects an estimated 1.2 million people in the U.S., with approximately 50,000 new cases developing yearly. Up to 1 in 4 people living with the infection is unaware of his or her positive status, wrote the task force.
HIV in South Los Angeles
The L.A. County Department of Public Health reports that in South L.A., there are an estimated 16 HIV diagnoses for every 100,000 people. Dr. Derrick Butler, the associate medical director at T.H.E. Clinic and the director of its HIV clinic, applauded the revised recommendations. But he also noted that compared to agencies like the CDC – which made its recommendations in 2006 – the task force was somewhat late to the game in terms of expanding its screening guidelines.
"If you're not testing for it, you're not going to find it," Butler said. "It's about case-finding and getting people tested."
There's no reason not to test for HIV, he said – it's a quick, simple, cheap test and can prevent the development of AIDS, not to mention the further transmission of HIV. Modern treatment of the infection is also highly effective, he said, and usually carries minimal effects. But HIV has "been pigeonholed" in the public eye as a "gay disease," he said, or as something that only affects people who take drugs via needles.
"HIV is another disorder out there that should be tested for," said Butler. "We test people for diabetes, for high cholesterol, for cancer all the time. We just spill [those tests] out and nobody raises an eyebrow. But when you're talking HIV, all of a sudden it's a huge issue."
The doctor noted that anyone who's had unprotected sex could be at risk of HIV – "period."
In South L.A., Butler added, "there's still a lot of stigma in the black and Latino communities around HIV – and ignorance." He said some of his patients haven't told their families about being HIV-positive.
"They hide the diagnosis because they're afraid or ashamed of how they'll be treated," he said.
Butler added that "some people believe" that HIV can be contracted through touching or kissing (which it can't), and said many believe if a person has the disease, that person has done something wrong.
A lot of times, said Butler, "you happened to have sex with the wrong person and you didn't know."
The new recommendations are driven in part by "convincing evidence that identification and treatment" of HIV is linked to a reduced risk of its becoming AIDS, especially if it's caught early. Early detection and intervention also decrease the chance that a person will pass the disease along to someone else, said the task force.
The recommendations garnered the task force's strongest possible grade – an A, which means the task force believes "there is high certainty that the net benefit is substantial."